Healthcare Provider Details

I. General information

NPI: 1588896773
Provider Name (Legal Business Name): JESSICA LYNN DAY M.S.W., LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2009
Last Update Date: 10/11/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 SW EVERETT MALL WAY STE A
EVERETT WA
98204-2715
US

IV. Provider business mailing address

15 SW EVERETT MALL WAY STE A
EVERETT WA
98204-2715
US

V. Phone/Fax

Practice location:
  • Phone: 425-348-6727
  • Fax: 425-259-3073
Mailing address:
  • Phone: 425-348-6727
  • Fax: 425-259-3073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberRC60056575
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW60958706
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: